A clinical tool to predict severe pain during wound dressing changes

Abstract

Dressing changes cause severe pain (ie, 8-10 on a 10-point scale) for approximately one-third (36%) of patients with open skin wounds. No tool exists that allows nurses to predict which patients are likely to experience severe pain during dressing changes. The aim of this study was to develop a clinical tool to predict severe pain during dressing changes using clinically accessible wound and pain predictors and to evaluate the diagnostic validity of this model. Using a cross-sectional design, a one-time study dressing change was conducted by the same wound care nurse on 445 subjects while concurrently measuring patient and wound predictors and pain intensity during the dressing change. Three predictors came out of the study as most useful for a clinical prediction tool: type of dressing, resting wound pain, and expected pain. Algorithms based on these predictors are presented, which can be applied in other settings to predict patients likely to experience severe pain during a dressing change. This is the first study to systematically examine a comprehensive set of wound and patient predictors for their individual and collective associations with pain during dressing changes using precisely defined and rigorously measured study variables. The ability to predict which patients are likely to have severe pain during dressing changes is critically needed so that they can be targeted for preventive pain control strategies.

Effect of Heated Saline Solution on Pain Intensity, Wound Bed Temperature, and Comfort during Chronic Wound Dressing Changes: Crossover Randomized Clinical Trial

“…Further, the type of dressing can influence the pain level during changes. 16 However, in this study, all patients were using products that are changed daily, such as hydrogels or enzymatic debridants, and occluded with gauze and bandages or a compress as a secondary dressing. Therefore, in the patients in this study, the type of coverage did not influence the level of pain.…”

“…Studies of this nature have not yet been carried out in patients with chronic wounds; the microenvironment of chronic wounds is different from that of acute wounds given high levels of proteolytic enzymes, inflammatory mediators, microorganisms, biofilm, and pain. [13][14][15][16] In addition, pain can cause or intensify psychological stress and anxiety-hence the importance of pain assessment in the care of patients with chronic wounds as well as the search for interventions to relieve pain. 17,18 Finally, promoting comfort is understood as a goal of nursing care for people with wounds, especially chronic wounds.…”